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Case of the Week #82

Clinical History

A 57 year old man had papillary
lesions on his palate, which were excised:

Grossly, verruciform
xanthoma appears as a raised granular or verrucous lesion. Histologically, the
characteristic finding is foamy macrophages within dermal papillae. The foam
cells are immunoreactive for CD68, vimentin and Factor XIIIa, and negative for
S100 and weak/negative for keratin. The overlying epidermis is either verruciform,
papillary or flat (Oral
Oncol 2003;39:325). No epithelial atypia is present.

The differential diagnosis includes
squamous cell carcinoma, verrucous carcinoma and condyloma acuminatum. All of
these entities lack prominent foamy macrophages. In addition, the lack of
atypia rules out squamous cell carcinoma. Verrucous carcinoma is composed of lobules of mature
squamous epithelium with minimal atypia, but they are ulcerating or fungating.
Condyloma
acuminatum has prominent koilocytosis in the upper epidermis that is not found
in verruciform xanthoma.